Provider Demographics
NPI:1205016953
Name:HERSHLINE, ROGER KENNETH (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:KENNETH
Last Name:HERSHLINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 PENDER LN
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29928-5905
Mailing Address - Country:US
Mailing Address - Phone:888-935-7539
Mailing Address - Fax:843-342-5924
Practice Address - Street 1:3 PENDER LN
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29928-5905
Practice Address - Country:US
Practice Address - Phone:888-935-7539
Practice Address - Fax:843-342-5924
Is Sole Proprietor?:No
Enumeration Date:2007-11-10
Last Update Date:2007-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMD 27824207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine